In order to be effective, efforts to improve compliance with handwashing guidelines must be multifaceted. Alcohol hand rubs (with emollients) need to be provided at each patient's bedside. Issues surrounding healthcare workers' skin irritation need to be addressed urgently.

No abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. Direct observation is the recommended audit method but is associated with a number of disadvantages, including potential for being observed to alter usual behaviour. The Hawthorne effect in relation to hand hygiene is equated with productivity by increasing the frequency that hand hygiene is undertaken. Permanent repository linkUnobtrusive and/or frequent observation to accustom staff to the presence of observers are considered acceptable ways of reducing the Hawthorne effect but little has been written about how to implement these techniques or assess their effectiveness. There is evidence that awareness of being watched can disrupt the usual behaviour of individuals in complex and unpredictable ways other than simple productivity effect. Health workers might defer or avoid activities that require hand hygiene in the presence of auditors but these issues are not

Infection prevention and control experts have expended valuable health service time developing and implementing tools to audit health workers' hand hygiene compliance by direct observation. Although described as the 'gold standard' approach to hand hygiene audit, this method is labour intensive and may be inaccurate unless performed by trained personnel who are regularly monitored to ensure quality control. New technological devices have been developed to generate 'real time' data, but the cost of installing them and using them during routine patient care has not been evaluated. Moreover, they do not provide as much information about the hand hygiene episode or the context in which hand hygiene has been performed as direct observation. Uptake of hand hygiene products offers an inexpensive alternative to direct observation. Although product uptake would not provide detailed information about the hand hygiene episode or local barriers to compliance, it could be used as a continuous monitoring tool. Regular inspection of the data by infection prevention and control teams and clinical staff would indicate when and where direct investigation of practice by direct observation and questioning of staff should be targeted by highly trained personnel to identify local problems and improve practice.

Background Numerous studies demonstrate that the Hawthorne effect (behaviour change caused by awareness of being observed) increases health workers' hand hygiene adherence but it is not clear if they are methodologically robust, magnitude of the effect, how long it persists or whether it is the same across clinical settings.Objective Determine rigour of the methods used to assess the Hawthorne effect on hand hygiene, effect size estimation, variations between clinical settings and persistence.Methods Systematic literature review with meta-analysis.Results Nine studies met the criteria for the review. Methodological quality was poor.Data pooling was possible across six studies. The Hawthorne effect ranged from 4.2% to 65.3% with a median of 35.6%. It was 4.2% in one study conducted in intensive care and 16.4% in transplant units. It was most marked when data were collected across an entire hospital and in a group of general hospitals. Differences between wards in the same hospital were apparent. In the two studies where duration was estimated, the Hawthorne effect appeared transient. Conclusions Despite methodological shortcomings the review indicates clearevidence of a Hawthorne effect on general wards. There is some evidence that it may vary according to clinical specialty and across different wards within the same organisation. The review identifies a need for standardised methodologies to measure the Hawthorne effect in hand hygiene to overcome the dilemma of reporting the potentially inflated rates of adherence obtained through overt audit. Occasional covert audit could give a better estimation of 'real' hand hygiene adherence but its acceptability and feasibility to health workers need to be explored.

ObjectiveTo explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions.DesignScoping review.MethodsA methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013–2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted.ResultsFrom an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to one that involves a collaborative relationship between HCPs and patients. This change should be underpinned by a clear understanding of patient roles, potential levels of patient involvement in IPC and strategies to overcome barriers to patient involvement focusing ontheprofessional–patient relationship (eg, patient encouragement through multimodal educational strategies and efforts to disperse professional’s power).ConclusionsThere is limited evidence regarding the best strategies to promote patient involvement in the implementation of IPC interventions and guidelines. The findings of this review endorse the need for targeted strategies to overcome the lack of role clarity of patients in IPC and the power imbalances between patients and HCPs.

The primary purpose of this quasi-experimental research is to observe health care workers' compliance with hand-hygiene guidelines during patient care in an intensive care unit in Ireland before (pretest) and after (posttest) implementation of a multifaceted hand-hygiene program. Health care workers' attitudes, beliefs, and knowledge in relation to compliance with handwashing guidelines were also investigated. A convenience sample of nurses, doctors, physiotherapists, and care assistants (n = 73 observational participants, n = 62 questionnaire respondents) was used. Data (N = 314 observations, 62 questionnaires) were analyzed descriptively and cross-tabulated using chi-square (Pearson's) and Mann-Whitney statistical tests. Results revealed that a significant shift (32%) occurred in health care workers' compliance with handwashing guidelines (pretest 51%, posttest 83%, p < .001) following the interventional hand-hygiene program. Significant changes were also found in relation to health care workers' attitudes, beliefs, and knowledge (p < .05).

Purpose -The purpose of this research is to explore healthcare workers' infection control practices from a behavioural viewpoint. Major behavioural theories are explored. Findings from a study which drew heavily from the PRECEDE theoretical framework are presented. The main purpose of this quasi-experimental study was to observe health care workers' behavioural compliance with hand hygiene guidelines during patient care in an Intensive Care Unit in Ireland before (pre test) and after (post test) implementation of a multifaceted hand hygiene program. Health care workers' attitudes, beliefs and knowledge in relation to compliance with hand-washing guidelines were also investigated. Design/methodology/approach -Data were collected through non-participant observation and survey methods. A convenience sample of nurses, doctors, physiotherapists and care assistants (n ¼ 73 observational subjects, n ¼ 62 questionnaire respondents) was used. Findings -Data (n ¼ 314 observations, 62 questionnaires) were analysed descriptively and cross-tabulated using Chi Square (Pearson's) and Mann Whitney statistical tests. Results revealed that a significant shift (32 per cent) occurred in health care workers' compliance with hand washing guidelines (pre-test 51 per cent/post-test 83 per cent, p , 0.001) following the interventional hand hygiene program. Similarly, significant changes were also found in relation to health care workers' attitudes, beliefs and knowledge ( p , 0.05). Originality/value -Findings from this paper are also of value to future researchers investigating any form of behavioural change. Recommendations from this study are that future research which aims to investigate behaviour should be underpinned by an appropriate theoretical framework. Only multifaceted interventions are justified.